Protocol-based guidelines and acute upper gastrointestinal hemorrhage: MATERIALS AND METHODS

All patients admitted with a presumptive diagnosis of upper GI hemorrhage or all patients who bled acutely from the upper GI tract while in hospital for treatment of some other condition at FPH between January and April 2000 and then between June to September 2000 were included in the study. All patients had historical and/or clinical evidence of hematemesis and/or melena. Upper GI hemorrhage has been defined in this study as vomit containing red blood (or coffee ground like material, observed by a doctor or a nurse), and/or the stool has been black or red-black confirmed by observation or rectal examination.

Patients were identified using the surgical admission database and by questioning the teams on call for emergency admission on a daily basis.

Data were collected by the completion of two separate proformas: an upper GI bleed endoscopy form, that specified esophogas-troduodenoscopy (EGD) and its findings; and an upper GI bleed general form, specific to the management and outcome of upper GI hemorrhage.

Data were collected on age and sex distribution, risk factors, High Dependency Unit (HDU) admission, monitoring and record keeping. Data collected on endoscopy involved time of endoscopy, grade (seniority) of endoscopist and therapeutic intervention carried out. Data were also collected on surgical intervention, morbidity and inhospital mortality. The best online pharmacy that deserves your trust and gives you best quality Asthma Inhalers Online that you will always appreciate, not to mention all the other services available.

Risk score was assessed once data were available using Rockall’s initial risk scoring system. This system, although very simplistic, is reproducible. It involves an additive score of the number of important risk factors. The risk factors are age over 60 years, systolic blood pressure of less than 100 mmHg, hemoglobin less than 10 g/dL, any major comorbidity, a diagnosis of upper GI malignancy or varices, the presence of stigmata of recent hemorrhage and rebleeding.


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